<!DOCTYPE html>
<html xmlns:th="http://www.thymeleaf.org"
      th:replace="fragments/layout(title='收费项目-现金支付')">
<div class="right" th:fragment="right">
            <!--面包屑-->
            <div class="breadcrumb layui-bg-gray">
                <span class="layui-breadcrumb" lay-separator=">">
                    <a th:href="@{/}">首页</a>
                        <a href="/receipt">收费管理</a>
                        <a href="/receipt">收费项目</a>
                        <a><cite>现金支付</cite></a>
                </span>
            </div>

            <!--主体内容区-->
            <div class="form-content">
                <form action="/receipt/paycash" method="post" class="layui-form">
                    <div class="layui-form-item">
                        <label class="layui-form-label">付款人</label>
                        <div class="layui-input-block">
                            <input type="text" readonly  lay-verify="required" th:value="${param.elderlyName}"  autocomplete="off" class="layui-input layui-disabled">
                        </div>
                    </div>

                    <div class="layui-form-item">
                        <label class="layui-form-label">应收金额</label>
                        <div class="layui-input-block">
                            <input type="text" readonly  lay-verify="required" th:value="${receipt.amount}"  autocomplete="off" class="layui-input layui-disabled">
                        </div>
                    </div>
                    <div class="layui-form-item">
                        <label class="layui-form-label">实收金额</label>
                        <div class="layui-input-block">
                            <input type="text" name="monery" required th:value="${receipt.amount}"  lay-verify="required" placeholder="请输入收款金额" autocomplete="off" class="layui-input">
                            <input type="hidden" name="code" th:value="${receipt.code}">
                        </div>
                    </div>
                    <div class="layui-form-item">
                        <div class="layui-input-block">
                            <button class="layui-btn" lay-submit lay-filter="submitBtn">确定收款</button>
                            <a href="/receipt" class="layui-btn layui-btn-primary">返回</a>
                        </div>
                    </div>
                </form>
            </div>

        </div>

</html>